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Abstract

Background: Sudden deaths in young competitive athletes are highly visible and tragic events, which receive much public visibility. However, little is known regarding the specific impact of gender on these events.

Methods and Results: The U.S. National Registry of Sudden Death in Athletes was accessed to identify the causes, frequency and epidemiology of sudden deaths in U.S. competitive athletes by gender. A total of 2,408 deaths (2155 male; 253 female) were identified in athletes engaged in 41 diverse organized sports from 1980 to 2011. Most sudden deaths occurred with physical exertion during competition/training (66%), and were predominantly due to cardiovascular disease (54%). In high school and college athletes, accounting for participation rates, the ratio of male to female deaths was 5.4:1. Males were somewhat older than females (19±6 vs. 17.8±6; P=0.003), and were more commonly black (30% vs. 17%; P<0.001). Of the male athletes, the highest rate of cardiovascular sudden death was in blacks (65% vs. 49% in whites; P<0.001). The most frequent sports were football (n=725) and basketball (n=437) in males, and basketball (n=47) and cross country/track (n=41) in females. Most common cardiovascular cause of death was hypertrophic cardiomyopathy (HCM), which accounted for a greater proportion of confirmed cardiovascular deaths in males (47%) vs. females (14%; P<0.001); a 19:1 male:female ratio in high school and college athletes. In contrast, females experienced greater frequency of death due to congenital coronary artery anomalies (30% vs. 14%; P<0.001), arrhythmogenic right ventricular dysplasia (12% vs. 4%; P=0.018), and long-QT syndrome (7% vs. 1%; P<0.001). Blunt trauma, including commotio cordis, occurred more frequently in males (24% vs. 15% in females; P=0.001).

Conclusions: Female athletes have a 5-fold lower risk for sudden death, compared to males, and were almost 20-times less likely to die of HCM. Black males had the highest rate of sudden death due to cardiovascular disease, with HCM most common.